Assessment

 Borderline Personality Disorder Severity Index

Assessment of psychiatric comorbidities in BPD

Comorbid conditions	Clinical presentations	Clinical instruments
Major Depressive Disorder (MDD)	Episodes of major depressive disorders (MDD) are not uncommon among individuals with BPD, especially during stress. Additional treatment of MDD is essential during the episode.	Hamilton Depression Rating Scale (HDRS)  Or PHQ-9
Dysthymia	Persistent low-grade depressive symptoms with distress lasting for years (≥2 years) is a common finding in BPD.	Cornell Dysthymia Rating Scale (CDRS)
Anxiety and panic attacks	Acute anxiety attacks and panic attacks are common manifestations of BPD. Episodes of attacks are more pronounced at times of perceived abandonment or rejection.	Hamilton Anxiety Rating Scale (HAM-A) Or GAD-7
Insomnia	Insomnia is frequent. Comorbid depression, anxiety or substance use may add to the dysfunctions related to BPD.	Pittsburgh Insomnia Rating Scale (PIRS) or Pittsburgh Sleep Quality Index (PSQI)
Somatic symptom disorder (SSD)	Somatoform pain symptoms are often a significant cause of occupational dysfunction in individuals with BPD. Adequate pain management significantly improves the quality of life.	Patient Health Questionnaire-15 (PHQ-15)
Dissociative disorders	Stress-induced dissociative episodes are common. Comorbid substance use disorder or depressive episode imparts diagnostic and management difficulties. Dissociative identity disorders are amongst the most difficult to manage.	Dissociative Experiences Scale (DES)
Impulse control disorder (ICD)	Intense anger may lead to harm to self and others. An additional diagnosis of ICD may be provided when impulse control issues predominate the clinical picture and pose significant dysfunction.	Minnesota Impulse Disorders Interview (MIDI) or other Impulsiveness Scales
Substance use disorders	Comorbid substance use poses a significant burden on physical and psychological health. The risk of impulsive harm to self and others is higher during episodes of intoxication and withdrawal.	Alcohol, Smoking and Substance Involvement Screening Test (ASSIST)
Brief psychotic episode	Stress-induced paranoid symptoms lasting for a few hours are common. Additional diagnosis of brief psychosis may be required when psychosis persists for more than one day.	Brief psychiatric rating scale (BPRS)
Posttraumatic stress disorder (PTSD)	Childhood physical and sexual abuses are common. A comorbid diagnosis of PTSD may be provided when presented independently. When symptoms of BPD emerge after significant, chronic or repetitive psychological traumas, a diagnosis of complex PTSD may be given.	PTSD symptoms scale (PSS) Or PCL-5
Eating disorders (ED)	Bulimia and other eating disorders can be present as comorbid conditions with BPD. Body image disturbance is common in both anorexia and BPD. An additional diagnosis should be given when the diagnostic criteria for an independent eating disorder are met.	Eating Disorder Diagnostic Scale (EDDS) or the Eating Disorder Examination Questionnaire (EDE-Q 6.0)